That's oh-be-GUY-n, not oh-be-GIN, as some (primarily people from Texas) would like to refer to my chosen profession. Although, working in this field can sometimes cause one to develop a penchant for gin...hmmm.

Thursday, October 26, 2006

Why I Love My Nurse(s)

When I left you last, I gave you the somewhat faulty impression that I had, indeed, become SuperMom, curing sore throats and doing household chores at the speed of sound. In reality, my sick baby took a 3 hour nap, I sorted and did exactly 2 loads of laundry, passed on cleaning the kitchen in favor of reading blogs, and, instead of cooking, my husband brought home take-out for dinner. Domestic goddess, I am not. Fortunately, CindyLou awakened from her power nap afebrile and happy as a clam. I expect she will make a full recovery, and she is back to requesting chocolate for dinner (she is totally my daughter). I went back to being a physician, and had a relatively good Wednesday.

I fully expected to have a crappy day today. I had 14 new patients on the schedule, and I had 45 total patients on my list. I also was continuing an induction from yesterday, a primip that was post-dates with pre-ecclampsia. She never dilated more than 1 cm all day long yesterday, so I was worried about her progression, and I was really hoping to avoid a C-section, if possible. I don't know what is up with my schedule, but I started the day in a foul mood. My clinic nurse, SuperNurse, listened to my venting and told me that it would all be alright.

Let me expound, for a minute, on why I love her so very much. She takes care of me like I am one of her own children, she trusts me enough to let me care for her daughter (her daughter is 20 weeks pregnant), she loves my daughter like a grandchild (and CindyLou loves her!), she has been CindyLou's babysitter by choice, she answers my phone messages, deals with difficult patients, triages my patients, and assists me with exams and procedures, she gave me my flu shot and it didn't even hurt, and today, since she was worried that I wouldn't have time to eat, she brought me a salad and pepperoni roll from her own house so that I would have lunch. I love her to pieces, and she is never allowed to leave me. I had my own private hissy fit about my schedule for the day, she listened patiently, and then I got to work.

By the grace of God, I had numerous cancellations today, lightening the schedule significantly. As I trudged through clinic, I was in touch with my patient's labor nurse often throughout the day. Yesterday this patient had received Multiple doses of cytotec, yielding many contractions, but very little cervical change. When I rounded in the morning, she was 2cm/70% effaced/ and -2 station. I was hopeful for a vaginal delivery, but whenever you encounter such an unfavorable cervix, it is always a concern that the induction will fail. I was surprised (and pleased) to learn that she had dilated to 5 cm in just under 3 hours. The labor nurse, a seasoned professional with 20 years of experience under her belt, stated that the patient was having a few decelerations, but the baby was responding to scalp stimulation, and the labor was progressing well. I trusted her clinical judgment, and proceeded through my clinic day. Imagine my surprise when she paged me at 2:30 pm, stating that the patient was completely dilated! I quickly completed my remaining office visits, cancelled the remainder of the afternoon, and dashed to the hospital.

My patient delivered her long-awaited baby in a mere 4 pushes, and the baby was perfect, with Apgars of 9 and 9. After the delivery was completed and I sat at the nurses' station, completing paperwork, I asked the labor nurse to pull the strip from earlier, when the baby was having decelerations. Ladies and gents, the strip was U.G.L.Y. (you ain't got no alibi you ugly, hey, hey, you ugly...um, sorry, latent cheerleader tendencies emerging, here...nothing to see) It showed repetitive late decelerations and minimal beat to beat variability, for a good 20 minutes. Any other, less experienced, nurse likely would have pulled the plug on this patient due to the non-reassuring strip. This nurse, however, repositioned, started oxygen, gave positive scalp stim, and did not panic. It was fortutitous that this seasoned nurse held steady with the patient and worked steadfastly to improve the fetal status. Because of her expertise and confidence in the face of a non-reassuring strip, not only did she save my patient's peace of mind, she preserved her ability to proceed with a vaginal delivery.

Nurses save my butt every single day, and while I do my best to thank them, I fear it just isn't sufficient. So, to all you nurses out there, regardless of your specialty, thank you a million times over for everything that you do. Nursing can be such a thankless job, and you deserve so much more. Hug your nurses today, folks, they are the heart and the soul of good medical care, without them, we physicians would be lost.

15 comments:

Nurses have also been known to save the bum of a certain lost looking medical student on many occasions when she had no idea where to go for observerships, how to get scrubs from evil scrub machine, or was falling asleep during ophthalmologic surgery due to the frigid conditions. Thank you nurses everywhere!

RE SuperNurse and the domestic goddess routine: this is why men have wives. And it’s why all societies pay their doctors enough to hire domestic help: doctors need to be available, and they can’t be available if they’re tied down with domestic duties.

I’m not sure it’s fair to SuperNurse to expect her to be a wife to you in addition to being a professional and a friend. If you rely on her to make you a sandwich in the morning for your lunch, then something’s wrong.

I’m not saying that you are asking SuperNurse to do all this stuff for you, but she does it and you accept it. If you hired a housekeeper to do your laundry and clean up the house while you were at clinic, then you’d have time to make your own lunch. Which would be more respectful of SuperNurse.

Giving a shout-out in praise of nurses who act as wives without recognising what’s going on is kind of like Mother’s day, where once a year Mom is give roses and breakfast in bed to praise her for sacrificing her own life to care for others. Or Secretary’s Day to recognise the poorly-paid women who do the scut work to free their colleagues to make lots of money. Except that Secretary’s Day and your shout-out are even worse than Mother’s Day: the wife who sacrifices herself for her husband’s profession gets to live in the house her husband buys, and keep it and her husband’s pension after he dies. SuperNurse, however, does not live in a house bought with your pooled incomes and is not going to be a beneficiary of your pension.

My mother — a professional who married young and raised five children — has always been adamantly against Mother’s day, by the way. She taught us that nobody sacrifices themselves and that we are all expected to do our part.

I think you understand some of the issues because in your final paragraph thanking both SuperNurse and the labor nurse, you say “they deserve so much more.” Yes, they do. But I’m not certain that a hug is the answer.

My nurses delivered my last baby (5th born) who had big and bad meconium. I tried hard not to push to wait for my ob, but that didn't happen. As the fluid broke with the first push, the nurse catching (bed not down yet) sat at my feet and carefully caught the head, and yelled for a DeeLee (I think). The other nurse came over because they couldn't find it fast enough and caught the body keeping my baby very still. They carried her to the warmer (probably not yet warm) and suctioned her, intubated, and got her from an apgar of 1 to an apgar of 7, then of 8. She was in my arms in less than 15 minutes with all that work. My poor ob (who was called on a night off call because she likes to deliver her own patients) came in to deliver the placenta "woo hoo." The nurses were wonderful the entire time. Knowing I delivered my last one fast (with out a nurse or doctor onto the unbroken bed...at my feet with mec), the two met me when I came up to the counter and escorted me to my room. They said they had been arguing over who would get to catch the baby. Funny, they both did!

medstudentitis~ Nurses are definitely a student's very best friend. :)

geena~ Kudos and so much more :) Thank you.

Alison~ Um, wow. I'm rather taken aback by your stance, but far be it for me to try to change the way you view the world. I write this blog as an emotional and intellectual outlet. It is a place where I can sort my feelings and experiences in an anonymous setting. It seems as though you are of the opinion that if you make enough money, you should hire out help, and only worry about your own professional duties. To the exclusion of everything else? I happen to disagree.

I also think that you misunderstand my relationship with SuperNurse. I, of course, do not ask her to be my "wife," cook my meals, or tend to any of my household duties. At. All. She, out of the goodness of her own heart, and because she is not only my nurse, but my *friend* brought lunch for me on a day she knew we would be busy. It would be disrespectful to *not* accept her kindness. To reject her kind gesture would have been supremely insulting to her. It is not uncommon for me to bring in breakfast, snacks, or to buy lunch for my entire office on a regular basis. Should they be insulted?

I never asked her for anything, but she offered her friendship freely. As for her "not getting a cut" of the money that I am earning as a physician, she is a paid professional, as are all nurses. Her job is to triage patients, answer phone messages, and assist with exams. Luckily for me, we get along on a personal level, as well, and she happens to love my daughter. This is a bonus. This is what you call friendship.

I treat the nurses with whom I work with the utmost respect every single day, regardless of whether or not I sing their occasional praises on my personal blog (that none of them know exist, much less read). I didn't write my post to "shout out" or to preen, which, it seems, you are implying. As for hiring help, I do have a service that comes in every 2 weeks to do heavy cleaning duties. My daughter is in day care full time. I have neither the resources (hell, I don't know what you envision, but most physicians don't get paid nearly as much as you seem to think they do) nor the desire to have a live-in domestic housekeeper to raise my daughter and to fold my laundry for me. I'm still a mother and a wife, and I want to have a large part of raising my daughter and keeping my household...even if I suck at housekeeping! I've always been somewhat lackadasical when it comes to cleaning duties, even as a student, making no money and living on $12,000 dollars a year, with all nights and weekends off.

If you've read the rest of this blog, then you would know that I, as a physician, am on the pager (and therefore available) 24 hours a day and 7 days a week, excluding every other weekend (a recent development, by the way). Even when I cancelled my afternoon patients, I was still available via pager for non-emergent patient care. I disagree that "just doing your part" precludes sacrificing yourself; health professionals *do* sacrifice themselves for the greater good, every single day. I'm not asking for thank yous, but I am expressing my gratitude for those in the trenches with me.

jawndoejah~ Yup, labor nurses definitely get to catch their fair share of babies! It's great that you had two nurses helping you when you needed it, and that they got your baby perked up quickly.

There have been times when I have been just down the hall in the next patient's room and not made a delivery...especially in multiparous patients! Once, the daddy got to catch! :)

Doc--great post! (and well-stated response to Alison) I hope you will consider submitting this post to Change of Shift, the weekly nursing carnival much like Grand Rounds. The next one will be on Nov. 2, hosted by Disappearing John at http://disappearingjohn.blogspot.com.

Dr. Whoo, don't sweat Allison's post. She took it the wrong way or perhaps was treated indifferent by a physician. We all know that you value your nurse's friendship/professional skills. I mean who wants to work with someone that is a jerk. Having a friend makes it easier and better.

As a curse, I too offer my thanks for the pat on the back... I am lucky to work with a great set of Docs who do tkae the time to show their appreciation, and it does make the job a lot more fun when it is delving into its not so fun moments..

I got a link to this post from another reader because I am hosting this weeks "Change of Shift", a blog carnival of posts dedicated to nursing. I would like to include it in the carnival, but of course would need your permission to do so..

Hi anon~ Thank you for your kind words. No sweat here. :) I suffer no delusions that there are not jerk physicians out there, but it's not fair to paint us all with the same brush. Being friends with the people with whom I work makes life so much better.

borneobreezes~ Thank you and glad you liked the post!

disappearingjohn~ Welcome and thank you! I am truly flattered! You have mail, and permission to include the post. Thanks again. :)

Hi, can I ask you, I thought c-sections were routine surgeries for ob gyn's...I actually thought they preferred c-sections to natural deliveries b/c it is more convenient, less risky as the whole process is more controlled. Is this true or not?

hi anon~ I can't speak for all OB/GYN physicians, but I much prefer a vaginal delivery to a c-section. C-sections are "routine" surgeries, but all surgeries have associated risks that are not routine. Control can become chaos, should complications arise. There are times when a cesarean delivery is necessary for fetal or/and maternal well-being, of course.

Normal labors and deliveries can, at times, be "less convenient" but I didn't go into this field expecting 9 to 5 hours, you know? My interest still lies in what is best for both patients, mom and baby. I hope that you continue reading, and I am happy to answer your questions any time.

Followed this link from Change of Shift...I am a bit of a medblog junkie. I enjoyed your post. I am not in the medical field but I think we all need good working frienships without them there would be no joy in our jobs! I am glad that you have a good relationship with your nurse. I am sure you two make a good team.

I just read this post again, linked over from change of shift. It makes me want to run to Nurse Lorie and give her a wet sloppy kiss on the mouth. Like Supernurse, mine is all about efficiency, care of my needs and, most of all, PATIENTS. I share her with six or seven other faculty docs and several residents, but she is never overwhelmed. She has great leaderhship skills and her MAs & LPNs admire her and trust her to not stab them in the back. Need I say it again? I LOVE THIS WOMAN!

an unconventional mother~ Hi and welcome! I am glad that you enjoyed the post. Having friends in the office definitely makes the work easier. We make a great team, and I do my best to let her know how much she is appreciated. Hope to see you back!

FD~ I totally understand this sentiment. I had awesome nurses and office staff as a resident. I appreciate them that much more now, out on my own. They are truly stellar. Now if only you would give her part of your pension...;)